Summary: A new study in US veterans shows that EAET is quite effective for pain relief in psychiatrically complex patients, especially in the long run. Further, this therapy is far more effective than CBT for chronic pain.
A new randomized clinical trial confirms the efficacy of Emotional Awareness and Expression Therapy (EAET) in managing chronic pain. Such interventions are especially useful for so-called psychiatrically complex patients. These are often patients living with chronic pain along with multiple mental health issues.
It has long been known that chronic pain, unlike acute pain, requires a complex approach and that there is a significant role of emotional disorders in these painful conditions. That is why doctors often use antidepressants, anxiolytic drugs, and other therapies focused on emotional well-being to help these patients.
Unlike medical drugs, non-pharmacological therapies are safer and often more effective, though they might require prolonged effort, and they are also more challenging to implement.
The findings of this new study were published in the JAMA Network Open. This study was conducted among veterans from 2019 to 2023. All the participants were complex patients, as they were not only living with chronic pain but also had many other issues like anxiety, depression, PTSD, and other mental health issues. The study found that EAET is better than cognitive behavioral therapy (CBT) for managing chronic pain in such patients.
CBT is frequently used to manage mental health issues and has proven efficacy. This kind of psychotherapy tries to modify a patient’s thinking pattern and behavior. In contrast, EAET is more focused on exploring various emotions, including uncomfortable past experiences, thus gaining better emotional awareness, resulting in better physical health and reduced pain sensation.
This study was done with 126 participants, predominantly males, and almost half of them were African American, with an average age of 72 years. Most patients completed the treatment. However, the bigger surprise was that EAET was much more effective than CBT for pain relief after six months of follow-up (63% vs. 17%). Since the difference between these two therapies is massive, it would be correct to say that EAET is much more effective.
Researchers say that they also made some interesting findings. In many patients, pain is made worse by specific emotional responses, as most of these individuals are living with anxiety, depression, and PTSD. However, once patients realize the role of emotional responses in chronic pain, they are able to overcome their chronic pain more effectively.
With the right kind of education and training, patients are able to identify emotional triggers, and they are also able to handle stress better. All this results in better and faster pain control.
Of course, the more severe the emotional symptoms, the greater the requirement of the therapy. Those with more severe emotional issues require prolonged therapy and longer sessions. Many of them might not show much benefit initially, and they need time to overcome their emotional issues.
In EAET, patients learn to understand and express their emotions related to pain. This way, they are able to address underlying factors that are causing or making their pain worse over time. Since EAET is able to address emotional issues better, it is also associated with better pain relief in the long term.
Of course, this study has some limitations, such as most of the participants being older adults and veterans.
However, researchers noted that there is one distinct benefit of EAET – it can be delivered through telehealth platforms. Thus, now researchers are exploring and testing these new ways of delivering EAET, which may ultimately benefit a larger number of individuals.
Frequently asked questions
How does emotional awareness and expression therapy work?
In EAET, patients learn to understand and express the emotions tied to their pain, including uncomfortable past experiences. Once a patient sees how emotional responses feed the pain, they learn to spot their emotional triggers and handle stress better. That work goes after the factors that cause pain or make it worse over time.
Is EAET better than CBT for chronic pain?
In this trial, yes, by a wide margin. Among 126 US veterans with an average age of 72, 63% of those treated with EAET had pain relief at six months, compared with 17% of those treated with cognitive behavioral therapy (CBT). CBT works on thinking patterns and behavior; EAET works on the emotions underneath the pain.
Who benefits most from emotional awareness and expression therapy?
EAET is especially useful for psychiatrically complex patients: people living with chronic pain along with anxiety, depression, PTSD or other mental health issues. The more severe the emotional symptoms, the longer the therapy and the longer the sessions. Some patients show little benefit at first and need time before the pain relief follows.
Can EAET be done through telehealth?
Yes. One distinct benefit of EAET is that it can be delivered through telehealth platforms. Researchers are now testing these remote ways of delivering the therapy so it can reach a larger number of people living with chronic pain.
Source:
Yarns, B. C., Jackson, N. J., Alas, A., Melrose, R. J., Lumley, M. A., & Sultzer, D. L. (2024). Emotional Awareness and Expression Therapy vs Cognitive Behavioral Therapy for Chronic Pain in Older Veterans: A Randomized Clinical Trial. JAMA Network Open, 7(6), e2415842. https://doi.org/10.1001/jamanetworkopen.2024.15842
Dr. Gurpreet Singh Padda, MD, MBA, MHP
